title: Inappropriate shocks in patients with ICDs: single chamber versus dual chamber.
abstract: BACKGROUND
  Despite the technological evolution of the implantable defibrillator, one of the questions that remains is the possible benefit of the dual chamber versus single chamber implantable cardioverter defibrillator (ICD) in reducing inappropriate shocks.
  
  
  OBJECTIVE
  To evaluate which type of device provides fewer inappropriate shocks (dual chamber versus single chamber) in patients with implantable cardioverter defibrillators (ICDs).
  
  
  METHODS
  Meta-analysis of randomized studies published in the literature comparing dual-chamber implantable cardioverter defibrillators to single chamber devices which have been known to cause, as an evaluated endpoint, inappropriate shocks.
  
  
  RESULTS
  The dual-chamber implantable cardioverter showed no benefit in reducing the number of inappropriate shocks. In fact, the opposite was shown. In the analysis of fixed effects, the association tended to favor single-chamber implantable cardioverter defibrillators (OR = 1.53, CI 95%: 0.91-2.57), despite the absence of statistical significance (p = 0.11). We highlight the heterogeneity observed in the results (I² = 53%), which motivated a replication of the analysis using a model of random effects. However, significant differences remained in the occurrence of inappropriate shocks in both groups (OR = 1.1, 95% CI: 0.37-3.31; p = 0.86). To complement the analysis, we proceeded to perform sensitivity analysis, which showed that the exclusion of a study resulted in the lowest heterogeneity observed (I²=24%) and the association with inappropriate shocks significantly favored the single chamber cardiodefibrillator (OR = 1.91; 95% CI: 1.09-3.37; p = 0.27).
  
  
  CONCLUSIONS
  It was determined that there was no clear evidence of superiority of any of the devices evaluated.
authors.forename: Juliana
authors.initials: J
authors.lastname: Gonçalves
authors.forename: Telmo
authors.initials: T
authors.lastname: Pereira
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000628:therapy; D017147:Defibrillators, Implantable / Q000009:adverse effects*; D004554:Electric Countershock / Q000295:instrumentation*; D004867:Equipment Design; D019544:Equipment Failure Analysis; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016032:Randomized Controlled Trials as Topic; D018570:Risk Assessment